Tolerance: Psychosocial Factors
When symptoms recur unexpectedly after a period of having been well-controlled, a review of the following factors should be undertaken: sleep, mood, anxiety, and change in environment. Poor sleep can exacerbate ADHD symptoms. Patients who are getting less sleep or whose quality of sleep has declined can find themselves more distracted and forgetful during the day. One important cause of this is Obstructive Sleep Apnea. If patients are noticing that their ADHD symptoms are worse and that they are more tired during the day, a sleep study may be warranted to rule out this diagnosis.
Poor concentration and memory difficulties are diagnostic criteria for depression and anxiety disorders as well as ADHD. If an ADHD patient also suffers from one of these disorders, a depressive or anxious symptom flare may be responsible for worsening ADHD symptoms. Because patients are not always as aware of their emotions as they are their cognitive function, they may only perceive the attention problems. This is one of many reasons to have an open and thorough discussion with one’s doctor when symptoms return. Treating the accompanying disorder (either with medications or psychotherapy) will often ameliorate the new attention difficulties without requiring a change in stimulant dose.
A major change in environment, such as a new job or moving to a new apartment, will often temporarily exacerbate ADHD symptoms. Even if one is happy with the change, the new circumstances disrupt their routine. If this is the only reason discovered for symptom increase, as one adjusts to the new surroundings he or she can generally expect a return to previous functioning. Again, dose change is not usually required in these circumstances. Some patients find it useful to take a slightly higher dose during the adjustment period. The potential downside of this is that it may be difficult to return to the previous, lower dose once the body has adjusted to the higher one.
Last updated 12/2/17